EmailMe Form - Second Degree Application

Name *

First MI Last

Gender *

Date of Birth *

MM / DD / YYYY

Phone *

### - ### - ####

Email *

Address *

Street Address City State / Province / Region Postal / Zip Code Country / Region

LHU ID

If you cannot recall your ID, leave this box blank.

LHU Graduation Date *

MM / YYYY

Have you ever used any other name? *

Previous Name *

First Last

EDUCATION & EXPERIENCE

Degree(s) Earned *

Minor(s)/Concentration(s) Earned *

Degree You Wish to Pursue *

View available majors at www.LHUP.edu/majors.

Starting semester *

Year you wish to begin *

Ex. 2014

Campus Selection

Have you had communication with the department of your intended major? *

With whom have you spoken? *

If you can't remember, please enter N/A.

Have you attended any colleges/universities other than LHU? *

Please list the names and dates of all colleges/universities you have attended. *

Have you ever been convicted of a criminal offense? *

A criminal offense is defined as a felony. Please disregard: minor traffic violations, offenses committed before your 18th birthday which were adjudicated in juvenile court under a Youth Offender Law, and any charges which have been expunged by a court or for which you successfully completed an Accelerated Rehabilitative Disposition Program. A conviction is an adjudication of guilt and includes determinations before a court, a district justice or magistrate and pleas of nolo contender (no contest).

Please state the criminal offense and when it occurred. *

Please indicate your experiences since completing your first LHU degree (work experience, military, etc.) *